A Survey among the General Public and Licensed Pharmacists in New
Jersey and Oregon
Conducted on Behalf of RHTP

January 2000

Peter D. Hart Research
Associates

1724 Connecticut
Avenue, NW

Washington, DC20009

Results
of General Public Survey

From
November 17 to 23, 1999, Peter D. Hart Research Associates conducted a poll
among 506 New Jersey voters and 503 Oregon voters to assess their awareness of
and familiarity with emergency contraception, their feelings about emergency
contraceptive pills? being widely available to women, and their attitudes
toward collaborative drug therapy agreements and so-called ?conscience
clauses.?The margin of error
for each poll is ±4.5%.The
following memo presents the key findings of these polls.

Overview

The
research findings provide valuable insight into voters? approach to the
topic of emergency contraception (EC).As
the results of both polls demonstrate, emergency contraception is not a
subject with which most voters are familiar; however, once they learn more
about the subject, they are generally positive to the idea of emergency
contraception and its being widely available to women.

Perhaps
somewhat surprisingly, voters have mixed reactions to the concept of
collaborative drug therapy agreements between doctors and pharmacists, and
their reservations about these arrangements significantly affect their
feelings about making EC available through these types of agreements.Finally, while voters are largely unaware of the discussion of
so-called ?conscience-clause? legislation in their states, they express
strong opposition to these exemptions.

Knowledge of and Familiarity with Emergency Contraception

Many
voters have a general sense that a medical treatment exists for preventing
pregnancy after unprotected sex, but almost unanimously, voters know very
little about emergency contraceptive pills?from whether EC is even available
in the United States to how long EC pills are considered effective in
preventing pregnancy.About half
(47% in New Jersey, 51% in Oregon) of voters in each state say that they know
of a product or drug that has been proven effective in preventing pregnancy
after unprotected sex, but they admit that they are not particularly familiar
with the particular drugs.A
slightly higher proportion of voters in each state believe that they are very
or fairly familiar with the term ?morning-after pill? (23% NJ, 25% OR)
than with the term ?emergency contraceptive pills? (14% NJ, 17% OR).

Voters?
lack of knowledge of emergency contraception stems from their lack of personal
experience with EC:just one in
20 (5%) New Jersey voters and one in ten (9%) Oregon voters know of a family
member or friend who has taken emergency contraceptive pills.Even among the population whom one might expect would have the most
personal experience with EC?women age 18 to 44?only about one in ten (8%
NJ, 11% OR) say that they know someone who has taken emergency contraceptive
pills.In both states, barely one
in ten (7% NJ, 9% OR) 18- to 50-year-old women say that they have discussed EC
with their doctors or other health care professionals.

In
fact, emergency contraception remains such a remote topic to most of the
general public that a majority of voters are not even aware that emergency
contraceptive pills are available in the United States:just about one in three (30% NJ, 33% OR) voters in each state know that
EC is available in this country, compared with one in four (28% NJ, 25% OR)
who do not; the remainder admit that they simply do not know whether the drug
is available in America.Even
among voters who know that emergency contraceptive pills are available in
America, one in four (25%) New Jersey voters and one in three (34%) Oregon
voters do not know that these pills are available only by prescription.

Reaction to Emergency Contraception

Despite
their lack of familiarity with and knowledge of emergency contraception,
voters generally react favorably to the idea of emergency contraception?s
being widely accessible to all women.After
hearing a short description of emergency contraceptive pills, to clarify
voters? misperceptions and provide them with some context, approximately six
in ten (62% NJ, 64% OR) voters say that they feel very or fairly positive
toward the idea of EC?s being widely available.In fact, this sentiment is so widespread that a majority of voters in
almost all demographic groups?including Catholics?describe their reaction
to the idea as positive; Oregon Republicans are the exception, and even a
large plurality (49%) of them feel positive toward the idea.

The
positive aspects of emergency contraceptive pills? being widely accessible
are similar to many of the values that voters bring to the debate surrounding
other reproductive rights issues; for example, about one in five (23% NJ, 19%
OR) voters talk about EC as a ?personal decision? and a ?woman?s
choice.?They also volunteer
that emergency contraceptive pills would prevent unwanted pregnancy (12% NJ,
14% OR) and that the pills are a better alternative to abortion (6% in both
states).In fact, when read a
series of statements about why emergency contraceptive pills should be widely
available to women, voters in both states identify reducing the number of
abortions as the most convincing reason to support the accessibility of EC.

EC
is a better alternative to reducing unintended pregnancies than
abortion is

69

73

EC
is more effective the sooner it is taken; therefore, women need to be
able to get it quickly and easily

63

66

Half
of all pregnancies in the United States are unintended; EC is the
safest way to reduce this

56

59

EC
pills are just a higher dose of regular birth control pills and
therefore should be just as easily available

50

48

While
voters have a generally positive reaction to emergency contraception, they do
express concern about two distinct aspects of EC?s being widely available:the potentials for encouraging risky, unprotected sex, and abusing EC
as a regular, ongoing method of birth control.More than four in ten voters in each state?including a significant
proportion of voters who describe themselves as being positive toward EC?say
that these concerns are very or fairly convincing reasons why EC should not be
widely available to women.

Collaborative
Drug Therapy Agreements

Voters
are ambivalent toward the idea of collaborative drug therapy agreements
between pharmacists and doctors.In
New Jersey, 47% of voters describe these agreements as a bad idea, while only
33% describe them as a very or fairly good idea; in Oregon, reactions are more
evenly divided?40% think the agreements are a bad idea, as opposed to 38%
who believe they are a very or fairly good idea.While men in both states are more likely than women to see these
arrangements as a positive step, New Jersey and Oregon voters both seem
reluctant to diminish the role of doctors in prescribing drugs.And because voters have mixed reactions to the pros and cons of
collaborative drug therapy agreements, they are not particularly enthusiastic
about adding emergency contraceptive pills to the protocol of drugs that fall
under these arrangements.In New Jersey, 39% support adding EC to the list of
medications that pharmacists could prescribe directly to patients; 56% oppose
this measure.In Oregon, however,
51% favor adding EC to collaborative drug therapy agreements, while 44% oppose
this extension.

?Conscience-Clause? Legislation

Legislative
proposals in New Jersey and Oregon that would allow pharmacists to refuse to
fill prescriptions or provide medications because of religious or moral
objections?so-called ?conscience clauses??are not a topic with which
voters are familiar.In Oregon,
about half (52%) of voters say that they have heard nothing at all about these
proposals, whereas in New Jersey, three in four (74%) say the same.Despite their low levels of awareness of these legislative initiatives,
voters express strong and consistent opposition to these measures:eight in ten (79%) in New Jersey oppose this type of legislation, while
seven in ten (69%) in Oregon feel similarly.Conscience-clause legislation is rejected by sizeable majorities of
every demographic group of voters in both states.

In
explaining their opposition to these legislative measures, voters cite
pharmacists? ?professional obligation to provide patients with any drug or
medication that has been legally prescribed for them? as the most compelling
reason to reject these measures:70%
of voters in New Jersey and 62% of voters in Oregon rate this as a very
convincing reason to oppose conscience-clause legislation.At the same time, just about one in three (33% NJ, 35% OR) say that the
argument ? . . . it is the responsibility of the pharmacy?not the
pharmacist?to make sure that patients have access . . . to the drugs and
medications that they need? is a very convincing reason to support the
legislation.

In
the end, a majority (60% NJ, 53% OR) of voters maintain that pharmacists
should never be allowed to refuse medications to patients because of their own
religious or moral objectives?even when they are presented with the
alternative of allowing pharmacists to refuse prescriptions as long as the
pharmacy has a procedure for ensuring that patients are not denied care.

Results
of Pharmacists Survey

From
November 20 through December 3, 1999, Peter D. Hart Research Associates
conducted a poll among licensed pharmacists, 105 in New Jersey and 103 in
Oregon, on their knowledge of and feelings about emergency contraception, as
well as their attitudes toward collaborative drug therapy agreements and
so-called ?conscience clauses.? Only pharmacists who work for an
independent, chain, or supermarket pharmacy were interviewed in this survey.The following memo presents the key findings.

Overview

While
general familiarity with emergency contraception is widespread among
pharmacists, their actual knowledge of EC is inconsistent and, in some cases,
based on erroneous information.Despite
reporting a fair amount of expertise on the subject, a significant proportion of
pharmacists do not recognize some basic facts about EC, including how effective
it is, the time frame during which it can be taken, and how the pills work to
prevent unintended pregnancy.

The
overwhelming majority of pharmacists do not object to emergency contraception.And although some voice concerns about this method, most report that
these concerns do not interfere with their willingness to fill EC prescriptions
for patients.

Unlike
the general public, pharmacists have a decidedly positive view of collaborative
drug therapy between doctors and pharmacists.And also in contrast to public sentiment, pharmacists in both states
express strong support for so-called ?conscience-clause? legislation.

Knowledge of Emergency Contraception

Overwhelmingly,
pharmacists report that they are aware of an established medical treatment for
preventing pregnancy after unprotected sex?about nine in ten (90% in New
Jersey, 89% in Oregon) pharmacists in each state know of a product or drug that
is effective in this area.They
also are familiar with specific products to combat unintended pregnancy:80% of pharmacists in New Jersey and 74% in Oregon say that they are very
or fairly familiar with ?emergency contraceptive pills,? while 78% of
pharmacists in New Jersey and 70% in Oregon say the same about the
?morning-after pill.?

Despite
these claims, pharmacists still have many misperceptions of EC.For example, 59% in each state say that emergency contraceptive pills are
not considered safe for most women who have been advised not to take regular
birth control pills, despite scientific evidence to the contrary.In addition, a majority in each state incorrectly identify the time
period during which emergency contraceptive pills are considered effective, and
a significant minority underestimate the effectiveness of EC in preventing
unintended pregnancy.Another
common misperception with potentially important implications concerns how
emergency contraceptive pills actually work in preventing pregnancy:more than half of pharmacists in each state erroneously report that EC
can interrupt an established pregnancy by disrupting a fertilized egg that
already has become implanted.On
the other end of the spectrum, pharmacists know some basic facts about EC,
including its greater effectiveness when the pills are taken at an early stage
and the frequency of potential side effects associated with EC, such as nausea.

Pharmacists?
inconsistent knowledge of EC probably stems from their lack of significant,
direct experience with filling prescriptions for these pills.Three in ten (29%) pharmacists in New Jersey and more than four in ten
(44%) in Oregon say that they have not filled a prescription for these pills in
the past year, and among those who report having filled such prescriptions in
the past year, the vast majority report handling ten or fewer.

Reaction to Emergency Contraception

Like
the general public, pharmacists have a generally favorable reaction to emergency
contraception?s being broadly accessible to women:63% of pharmacists in New Jersey and 69% in Oregon describe their
reaction as positive.While strong
majorities of pharmacists in both states say that they do not have any moral or
religious objections to emergency contraceptive pills, some pharmacists do
express such reservations?about one in four (26%) pharmacists in New Jersey
and about one in five (19%) in Oregon say that they have concerns about EC.Among pharmacists who report having objections to emergency contraceptive
pills, however, the overwhelming majority say that these reservations are
personal (89% NJ, 70% OR), rather than professional.In the end, concern about widespread refusal by pharmacists to dispense
emergency contraceptive pills is more theoretical than practical, as only one in
20 (4%) New Jersey pharmacists and one in ten (10%) Oregon pharmacists say that
their feelings about EC would prevent them from actually filling prescriptions
for patients.

Even
though pharmacists are amenable to the idea of emergency contraception?s being
widely available to women, they do not believe that EC should be available over
the counter, without a prescription:73%
of pharmacists in New Jersey and 65% in Oregon oppose making EC available in
this way.Pharmacists in both
states also oppose making regular oral contraceptive or birth control pills
available to women without a prescription.

Collaborative Drug Therapy Agreements

Pharmacists
are enthusiastic about the idea of collaborative drug therapy agreements between
pharmacists and doctors.Unlike the
mixed reaction these agreements receive from voters in each state, a strong
majority of both New Jersey (71%) and Oregon (79%) pharmacists characterize
collaborative drug therapy agreements as a very or fairly good idea.

In
keeping with their favorable view of collaborative drug therapy agreements, a
majority of pharmacists support adding EC to the protocol of drugs that could be
prescribed under these arrangements:56%
of pharmacists in New Jersey and 67% in Oregon favor such an expansion.

?Conscience-Clause? Legislation

In
contrast to public opposition to legislative initiatives allowing pharmacists to
refuse to fill prescriptions because of religious or moral objectives,
pharmacists in both New Jersey and Oregon embrace so-called
?conscience-clause? proposals.Six
in ten (59%) pharmacists in New Jersey and seven in ten (68%) in Oregon support
such measures; in New Jersey, 79% of voters oppose them, while in Oregon, 69% of
voters reject them.Pharmacists in
Oregon report being the most aware of discussions of this type of legislation in
their state legislature:52% of
pharmacists in Oregon say that they have heard a great deal or quite a bit about
these proposals, compared with only 29% of pharmacists in New Jersey who say the
same.

In
the end, pharmacists? enthusiasm for conscience-clause legislation is tempered
somewhat by their support for a compromise solution allowing pharmacists to
refuse to fill prescriptions because of religious or moral objections only if
the pharmacy where they work has established procedures for ensuring that
patients are not denied access to these drugs as a result:about half (48% NJ, 54% OR) of pharmacists in each state select this
option as their preferred position.